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Radiology Residency Requirements For International Radiology Residents

Question By: Dr.Himansu Shekhar Mohanty

Do you take international radiology residents for your Radiology fellowships/residency? Is it mandatory to pass the USMLE for applying for fellowships? What score ideally do you suggest to have a good chance to get a fellowship in your department?

Best regards


Director’s Response To International Radiology Residents Question:

So to answer your questions, we have taken international radiology residents in the past. But more often, we take residents who are from the United States or residents that go to medical school in the Caribbean and then return to the United States. Nonetheless, some of our best residents have been foreign graduates!!

If you are coming from a foreign program, passing the USMLE is required. Typically, we use the scores as a baseline cutoff. Most importantly for us, we just need to know that you will be likely to pass the new written radiology core exam.  However, the cutoff varies from year to year depending upon the number of applicants and the overall competitiveness of the specialty for any given year. Usually, above 220 is a reasonable level but again that is a moving target. On occasion, we make exceptions if we know the applicant well, there are special circumstances, or the application is so outstanding that the person still merits an interview.

Hope that helps!!

Barry Julius, MD

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The Difficult Radiology Attending

difficult attending

Fortunately, most individuals in the radiology profession have stable, friendly personalities. But, in any room of 100 people, you will have psychopaths(1 out of 100), narcissists, borderline personalities (6 out of 100), in addition to other difficult personality types. And radiology is likely no different. During your radiology residency, you magnify these issues because you have to sit for a concentrated amount of time with this person. It could be for hours at a time. (Although that can be different now with the Covid pandemic!) So, you need to learn coping mechanisms to deal with these difficult people.

Why Difficult Radiology Attendings Are Not All Bad

Ironically, I found that some of these most difficult attending personalities gave me my best and most intense learning experiences. It’s where I learned to develop a thick skin, become more of an independent radiologist, tighten my dictation style, and listen. These were the formative years for me. If you think of this tough individual as another link in the chain of learning experiences, most of these days, weeks, or months you sit with this problematic attending will seem to have more relevance to your overall education. Your time spent will indeed not be perfect but will be much improved.

Personality Types

This segment will go through 12 different difficult personality types that you may encounter during your residency program. We will also teach you how you can use each problematic personality type to add to your body of experience and build you into a thriving radiologist.

The Narcissist

Everyone knows this individual. I personally always think of that main character from Dragon’s Lair(Dirk the Daring), with the perfect hair, the expensive clothes, and showing off their skills (or lack thereof!!!) to the world. As they say, “God’s Gift to Humanity.” These problematic individuals will often appear overconfident, and some will make fools of themselves. It’s going to be the attending that never uses liver windows because he says he can always easily detect all liver lesions in soft tissue windows. He’s just too good to make that extra effort.

What’s great about working with these sorts during your residency training? When you complete a rotation with this individual, you will learn how to avoid being overconfident and look more carefully in places that the narcissist will miss. Most important, it is a great time to learn how to be humble, an essential feature of a good radiologist. Radiologists cannot always be right!!!

The Know It All

If you were in school, this would be the talkative kid that is always raising his hand. Or think of Hermione from the Harry Potter series. This person can be incredibly annoying but smart and well versed. The know-it-all gives the resident a distinct learning experience but usually takes the thunder away from something that another attending or you may have discovered. As a resident, you have a lot to learn from this person. He or she will teach you all sorts of radiology information that others will not and give you a sense of humility.

The Absent Attending

You know this type of individual, always leaving the department at the drop of a hat. He/she expects you to do all the work for them during the day. And, the person is rarely available when you have pressing questions. I have found that this experience is probably one of the best learning experiences you can have as a resident. It allows you to take charge of a rotation that you usually would be merely following. You will need to look up lots of information on google and ask other residents/attendings what to do. When you finish with the rotation with this sort of difficult attending, you will be able to run the department because you will handle most of the day-to-day issues on your own, related to your experience of having the unavailable attending!

The Smitten Attending (With Someone Else!)

So, you are working in your interventional rotation, and your co-resident or a medical student is very handsome or pretty. Your attending does not seem to want to listen to anything you have to say. The “boss” always goes to the other resident to teach them and ask them questions and forgets about you. What do you do? Well, the answer is simple. You work twice as hard to get their attention. Working hard on this rotation may not pay off concerning getting a recommendation from this individual. Still, it will allow you to put your heart and soul into your work and make the rotation an intense work experience. You will live and breathe the subspecialty rotation. When you go into practice, you will be thankful for the extra time and expertise you may not have otherwise!!!

The Obsessively Detail Oriented Attending

When you come back from dictating a case, this is the sort of difficult attending that will mince every word and tell you why each word and phrase should have been different. Don’t take offense at this sort of mentor. Most of the time, they mean well. But, the experience of having to write the same dictation over and over; overcorrecting every statement until you make it the way he/she wants, can be painful. But, dictation is one of the more difficult elements in radiology to master. So, this experience can be invaluable for honing your reports and making them much more robust and exacting. Believe it or not, consider this person a resource to make them that much better!

The Sociopath

Watch your back! He/she will typically seem to be the friendliest radiologist in the whole department. This problematic attending often will tell you precisely what you want to hear. Until wham! At the end of the month, you find out that your evaluation from the program director is not what it initially seemed. The sociopath will not tell you about what he/she thought of you at the time of your rotation and takes pride in stealthily making the lives of the radiology resident miserable.

The good news is the rotation will seem to be just fine when you are there. It is only the afterglow that causes misery. But your experience with this attending will teach you something invaluable, never assume that everything is ok. Always ask and find out what you can improve and how you can do things better. This experience is a wake-up call for the naive resident!

Bizarro

Out of all the radiology personality types, believe it or not, you will find this one to be one of the most interesting. I can remember one of my former attendings telling me about a mentor who was continually drooling when he spoke and whose eyes were incessantly tearing. He stood at the short height of 4 foot 3. But, when you talked to this person, the passion for teaching and his profession shone through everything. These attendings tend to have some of the most diverse backgrounds and interests.

When you treat these folks as mentors/teachers, you find that they have unique ideas and behaviors that you would not learn from the more typical personality/appearance. I have incorporated their lessons into my daily practice. Also, I have found that their teachings tend to stick because of the unusual delivery and presentation. Typically, you will remember the days fondly that you work with these people and have good stories to tell as well!

The Dictator

You will find this problematic attending demanding and harsh. The dictator treats all his staff with an iron fist. This radiologist will appear unreasonable at times and expects everyone- nurses, technologists, residents- to bow toward every whim. Unfortunately, you will need to do the same or wait for his wrath. The environment may, at times, be unpleasant, and you will need thick skin. Still, I have found that these attendings make the residents more rigorous in their approach to running a department, adopting search patterns, and learning radiology. Use this opportunity to incorporate the dictator’s demands into your routine, and I can assure you, you will become a much better radiologist!

The Gossiper/Talker

You will have some of the best conversations with this attending and will learn about every character in the department. This person talks a lot and can prevent staff from getting their work done, And some of the information you may or may not have wanted to know. However, listen to this person very carefully because they can be an excellent source of information about what is going on in the department, a precious commodity. My advice is to reveal only what you want to expose to this attending, or else your story may become publicized as well!

The Inappropriate Attending

Most people know about this type of personality. He/she may yell at the patients, make off-color jokes with the wrong sorts of people, or maybe a little too touchy/feely. To this day, I use these uncomfortable situations to be instructive of what not to do as an attending radiologist. I use these experiences to remember to model good behaviors to my residents by the allegories/stories that have occurred!!!

The Loner

Many residents feel the need to get instantaneous feedback from their attendings. This problematic attending will not only give you refrain from any feedback, but he/she also may not even talk to you during your shared time. You may be “pulling teeth” to get this attending to teach and speak to you. You may feel like you are always being observed and assessed, but with no response. Remember that the world of radiology is not a specialty of instantaneous feedback. You may find out what you have done right or wrong months or maybe years afterward. This attending personality type truly prepares you for the real world!

The Unintelligible Radiologist

Most residents know this type. It’s the attending with tons of typos in their reports. And, clinicians are continually calling this attending to figure out what he reported in his radiology impressions. So what is the significant advantage of having an attending like this? You will need to learn how to field the clinician’s questions about his cases in a thoughtful, intelligent manner without incriminating its author. It’s a great way to solidify your radiology impressions and learn to communicate with the clinicians!!!

Bottom Line About The Difficult Attending

There are all sorts of personalities that radiology residents will encounter during their four years of training. I have probably just scratched the surface. Problematic characters can lead to trying times on a daily, weekly, or monthly basis. However, the experiences that you will have can be invaluable in your development as a radiology resident. Use these personalities to enhance your reputation and skills as a radiologist. Don’t let these difficult attendings get the best of you!!!